Plasma Exchange-Responsive Bulbar Dysfunction in Thymoma-Associated Myasthenia Gravis with Concomitant Lambert-Eaton Myasthenic Syndrome
Abstract
The coexistence of thymoma-associated myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) is rare, and no established therapeutic strategy exists for this condition. We herein report a case of MG-LEMS overlap syndrome (MLOS) in which plasma exchange (PE) effectively treated severe bulbar dysfunction refractory to intravenous immunoglobulin (IVIg). Sequential electrophysiological testing demonstrated an improvement in the low compound muscle action potential amplitudes and post-exercise increments, reflecting LEMS activity. This case highlights that PE may be more efficacious than IVIg for bulbar symptoms in MLOS, particularly with prominent presynaptic involvement, and supports electrophysiological assessment to guide treatment.
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BibTeX
@article{hayashi2026plasma,
title = {{Plasma Exchange-Responsive Bulbar Dysfunction in Thymoma-Associated Myasthenia Gravis with Concomitant Lambert-Eaton Myasthenic Syndrome}},
author = {Ryuichiro Hayashi and Takashi Hosaka and Makoto Terada and Shinji Saiki},
journal = {Internal Medicine},
year = {2026},
month = aug,
doi = {10.2169/internalmedicine.7609-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7609-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Plasma Exchange-Responsive Bulbar Dysfunction in Thymoma-Associated Myasthenia Gravis with Concomitant Lambert-Eaton Myasthenic Syndrome
AU - Ryuichiro Hayashi
AU - Takashi Hosaka
AU - Makoto Terada
AU - Shinji Saiki
PY - 2026
DA - 2026/08/19
JO - Internal Medicine
DO - 10.2169/internalmedicine.7609-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7609-26/_article
AB - The coexistence of thymoma-associated myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) is rare, and no established therapeutic strategy exists for this condition. We herein report a case of MG-LEMS overlap syndrome (MLOS) in which plasma exchange (PE) effectively treated severe bulbar dysfunction refractory to intravenous immunoglobulin (IVIg). Sequential electrophysiological testing demonstrated an improvement in the low compound muscle action potential amplitudes and post-exercise increments, reflecting LEMS activity. This case highlights that PE may be more efficacious than IVIg for bulbar symptoms in MLOS, particularly with prominent presynaptic involvement, and supports electrophysiological assessment to guide treatment.
SN - 1349-7235
SN - 0918-2918
ER -